Ep. 490 Uterine Fibroid Embolization: My Algorithm with Dr. Gary Siskin
Oct 22, 2024
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Dr. Gary Siskin, an esteemed UFE practitioner and professor at Albany Med, shares his expertise on uterine fibroid embolization. He discusses the evolution of fibroid treatment and the importance of collaboration with gynecologists. The episode delves into procedural insights, such as embolic agent selection and accessing uterine arteries, emphasizing patient-specific considerations for treatment. Siskin also highlights pain management and post-operative care strategies, advocating for patient education to promote awareness of this minimally invasive option.
Uterine fibroid embolization (UFE) presents a minimally invasive alternative to traditional surgical options like myomectomy and hysterectomy, providing comparable quality of life improvements.
Collaboration between interventional radiologists and gynecologists has been crucial in building trust and awareness for fibroid embolization, facilitating its growth within the medical community.
A comprehensive workup involving additional imaging is essential for accurately diagnosing patients with fibroids before recommending effective UFE treatment plans.
Deep dives
The Benefits of Fibroid Embolization
Fibroid embolization is a minimally invasive procedure that significantly benefits patients suffering from uterine fibroids. It offers a less invasive alternative to surgical options such as myomectomy or hysterectomy. Studies indicate that the quality of life and symptom improvement from fibroid embolization are comparable to these traditional surgical methods. Despite this, awareness about this treatment remains low, with less than 5% of patients with fibroids currently receiving it.
The Evolution of Fibroid Treatment
The treatment approach for uterine fibroids has evolved, particularly as interventional radiology has gained prominence in the medical community. Historically, there was skepticism among gynecologists regarding fibroid embolization, but collaborative efforts to educate and demonstrate the procedure have helped build trust. By involving gynecologists in the process, showcasing patient care, and emphasizing the skill set involved, interventional radiologist practices can gain credibility. The growth of awareness and acceptance within the gynecological community has been instrumental for the advancement of fibroid embolization.
Patient Workup and Imaging
A thorough workup for patients considering fibroid embolization begins with understanding their symptoms and gathering relevant medical history. Most patients are referred by their gynecologists and typically present with ultrasound reports showing the presence of fibroids. However, upon initial consultation, additional imaging, such as an MRI, is often conducted to confirm the diagnosis and assess any other underlying conditions. This comprehensive approach ensures that interventional radiologists have a clear understanding of the patient’s situation before recommending a treatment plan.
Procedure Techniques and Considerations
The technical aspects of fibroid embolization include careful catheterization and embolic agent selection to ensure effective treatment. The procedure begins with accessing the uterine arteries and navigating them using specialized catheters. Experienced practitioners monitor flow during embolization, ensuring that the procedure is effective and minimizes risks to surrounding tissues. The use of microspheres, such as embosphere, has become common due to their efficacy and predictability in blocking fibroid blood supply.
Post-Procedure Follow-Up and Patient Care
Post-operative care for patients who undergo fibroid embolization includes thorough follow-up to monitor symptoms and recovery. Patients receive initial contact from medical staff post-procedure, and follow-up appointments are typically scheduled three to four weeks later to assess healing and treatment effectiveness. While many patients do not require imaging at the initial follow-up visit, a follow-up MRI at six months post-procedure is often recommended to evaluate the shrinkage of fibroids. Ensuring ongoing communication and support for patients is essential to address any concerns they may have during recovery.
Get a second opinion on your uterine fibroid embolization (UFE) technique. Dr. Gary Siskin joins host Dr. Chris Beck for an in-depth discussion on his approach to uterine fibroid embolization, detailing techniques, tools, and embolic agents. Dr. Siskin is an experienced UFE practitioner, professor, and Chair of the Department of Radiology and Chief of the Division of Vascular & Interventional Radiology at Albany Med Health System in New York.
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This podcast is supported by:
Merit Embolotherapy
https://www.merit.com/solutions/embolotherapy/
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SYNPOSIS
Dr. Siskin shares his journey and evolution of his specialization in GYN-related interventional radiology procedures. The doctors cover various aspects of fibroid embolization, including its effectiveness compared to surgical options like myomectomy and hysterectomy, the referral and evaluation process, and considerations for fertility preservation. Pain management strategies and postoperative care are also explored, emphasizing the importance of patient education and interdisciplinary collaboration to promote less invasive treatments.
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TIMESTAMPS
00:00 - Introduction
04:45 - Building a Fibroid Practice
08:35 - Workup and Consultation
17:01 - Recurrence and Re-Embolization
20:27 - Pre-Procedural Workup and Technique
30:18 - Embolization Endpoint
36:07 - Accessing the Correct Uterine Artery
48:49 - Post-Procedure Patient Care
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RESOURCES
List of Publications by Dr. James B. Spies (PubMed):